Clinical Profile and Outcome of Poisoned Pediatric Patients Admitted To Poison Control Center, Ain Shams University Hospitals during the Year 2012

Abstract

Childhood poisoning comprises a significant component of injury-related morbidity and mortality all over the world and exerts a huge amount of pressure on the resources of the health care system as well as the workload on the health care staff. Early and accurate diagnosis and management of poisoning decrease the risk of morbidity and mortality. Therefore, study of manifestations and severity of poisoning by variable agents, effects of treatments and outcome is essential to assess the impact of poisonous substances and the effectiveness of treatment. Aim of the study: this study aims to determine the clinical profile, management and outcome of acutely poisoned children admitted to Poison Control Center (PCC), Ain Shams University Hospitals during a one year period starting from 1/1/2012 to 31/12/2012. Methods: The collected data from the cases’ medical records included: age, gender, delay time, pre-consultation treatment, clinical manifestations, findings of investigations, place and period of hospitalization, received treatment in the PCC and the outcome. Results: adolescence where the most frequent age group in this study and female gender was more prominent than male gender. Delay time was significantly increased in non-survivors than survivors. The proportion of deaths in group of patients who received pre-consultation treatment was significantly higher than that in patients who didn’t receive any treatment before arrival to the PCC. Faulty management in the form of induction of emesis by salty water intake was found in 2.6% of the cases; 7.7% of these cases were died. Most cases presented with unremarkable changes in vital signs and gastrointestinal manifestations (mainly nausea and vomiting) were the most frequent manifestations in the cases. Hypoglycemia, hyponatremia, hypokalemia and metabolic acidosis were the most common abnormalities found in laboratory investigations. Sinus tachycardia was the most common abnormality found in ECG. Most of the included cases in this study were admitted in the inpatient section (83 %). The majority of the cases (75%) were hospitalized for short period that didn’t exceed 24 hours. Higher PSS was associated with longer hospital stay periods. Corrosives, followed by pesticides were the most frequent cause of prolonged hospitalization (≥4 days). Emergency managements were indicated in 11% of the cases and procedures for gastric decontamination were done for 1296 cases (87.3%). All cases received supportive and symptomatic treatments. Atropine was the most frequent antidote that was used either alone or with toxogonin. The overall mortality ratio was 2.2%. Preschool age group had the greatest mortality ratio (3.7%), followed by infant group (3.6%). Hypernatremia had the highest case fatality rate (100 %), followed by CO poisoning (28.6%). Conclusion: Gastrointestinal manifestations (mainly nausea and vomiting) were the most frequent manifestations. Hypoglycemia, hyponatremia, hypokalemia and metabolic acidosis were the most common abnormalities found in laboratory investigations. Sinus tachycardia was the most common abnormality found in ECG. Corrosives, followed by pesticides were the most frequent cause of prolonged hospitalization. Atropine was the most frequently used antidote. The overall mortality was 2.2%. Hypernatremia had the highest case fatality rate (100 %). Recommendations: Increasing public awareness of the first aid measures in childhood poisoning is crucial to avoid complications of faulty measures. Also, it is important to increase public awareness of the services of the information center in the PCC as it presents guidance about management of poisoned cases. Ongoing childhood poisoning surveillance is needed to track its effects and risk factors and to monitor the impact of appropriate interventions.